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ABSTRACT: Patients with Huntington's disease (HD) are often described as unaware of their motor symptoms, their behavioral disorders or their cognitive deficits, including memory. Nevertheless, because patients with Parkinson's disease (PD) remain aware of their memory deficits despite striatal dysfunction, we hypothesize that early stage HD patients in whom degeneration predominates in the striatum can accurately judge their own memory disorders whereas more advanced patients cannot. In order to test our hypothesis, we compared subjective questionnaires of memory deficits (in HD patients and in their proxies) and objective measures of memory dysfunction in patients. Forty-six patients with manifest HD attending the out-patient department of the French National Reference Center for HD and thirty-three proxies were enrolled. We found that HD patients at an early stage of the disease (Stage 1) were more accurate than their proxies at evaluating their own memory deficits, independently from their depression level. The proxies were more influenced by patients' functional decline rather than by patients' memory deficits. Patients with moderate disease (Stage 2) misestimated their memory deficits compared to their proxies, whose judgment was nonetheless influenced by the severity of both functional decline and depression. Contrasting subjective memory ratings from the patients and their objective memory performance, we demonstrate that although HD patients are often reported to be unaware of their neurological, cognitive and behavioral symptoms, it is not the case for memory deficits at an early stage. Loss of awareness of memory deficits in HD is associated with the severity of the disease in terms of CAG repeats, functional decline, motor dysfunction and cognitive impairment, including memory deficits and executive dysfunction.
PLoS ONE 01/2013; 8(4):e61676. · 4.09 Impact Factor
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Parkinsonism & Related Disorders 08/2012; · 3.80 Impact Factor
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Parkinsonism & Related Disorders 08/2011; 18(2):213-4. · 3.80 Impact Factor
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ABSTRACT: We report 3 patients with typical clinical and electrophysiological characteristics of propriospinal myoclonus propagating from a thoracic spine generator.
In these patients, the pattern of recruitment of long-latency electromyographic reflexes in abdominal muscles was studied in response to various stimuli.
Abdominal reflex latency varied from 60 to 140 ms depending on stimulus location. Latency increased from magnetic stimulation of the thoracic spine to electrical stimulation of the supraorbital nerve, electrical stimulation of the median nerve, and magnetic stimulation of the motor cortex.
Long-latency abdominal reflex jerks are probably controlled by the brain stem to propriospinal system projections in patients with propriospinal myoclonus. The stereotyped pattern of recruitment of these reflexes could be of clinical utility to differentiate organic propriospinal myoclonus from psychogenic or mimicked jerks.
Movement Disorders 05/2011; 26(9):1759-63. · 4.51 Impact Factor
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ABSTRACT: A feeling of presence (FP), that is, the vivid sensation that somebody (distinct from oneself) is present nearby, is commonly reported by patients with Parkinson's disease (PD), but its phenomenology has not been described precisely. The objective of this study was to provide a detailed description of FP in PD and to discuss its possible mechanisms.
The authors studied 52 non-demented PD patients reporting FP in the preceding month (38 consecutive outpatients and 14 inpatients). FP characteristics were recorded with a structured questionnaire. The outpatients with FP were compared with 78 consecutive outpatients without FP.
About half the patients said they recognised the 'identity' of the presence. More than 75% of patients said the FP were not distressing, were short-lasting, were felt beside and/or behind the patient, and occurred while indoors; most patients checked for a real presence, but their insight was generally preserved. In 31% of cases, the patients had an unformed visual hallucination simultaneously with the FP. A higher daily levodopa-equivalent dose and the presence of visual illusions or hallucinations were independently associated with FP.
Although FP is not a sensory perception, projection of the sensation into the extrapersonal space, along with the frequent co-occurrence of elementary visual hallucinations and the strong association with visual hallucinations or illusions, supports its hallucinatory nature. FP may be viewed as a 'social' hallucination, involving an area or network specifically activated when a living being is present, independently of any perceptual clue.
Journal of neurology, neurosurgery, and psychiatry 05/2011; 82(11):1219-24. · 4.87 Impact Factor
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Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 12/2010; 121(12):2180-3. · 3.12 Impact Factor
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ABSTRACT: The authors describe the case of a 35-year-old woman with a history of an addiction to cigarette smoking who presented with an intracerebral hemorrhage from a ruptured arteriovenous malformation. The patient reported an immediate and complete disruption of her addiction to cigarette smoking following her stroke. Structural MR imaging revealed a lesion of the posterior cingulate cortex. Neuropsychological tests showed intact cognitive functioning. This observation suggests that the posterior cingulate cortex may play a role in the addiction to cigarette smoking.
Journal of Neurosurgery 12/2010; 113(6):1219-21. · 2.96 Impact Factor
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ABSTRACT: Psychological and behavioral disorders associated with Parkinson's disease can have a major impact on patients' and caregivers' quality of life. Depression, anxiety, psychotic symptoms (e.g hallucinations), apathy and impulse-control disorders raise questions as to the respective roles of premorbid vulnerability, disease-related factors, and drug adverse effects. These disorders are often difficult to manage, and there is an unmet need for controlled trials in this field.
Bulletin de l'Académie nationale de médecine 10/2010; 194(7):1305-18; discussion 1318-9. · 0.25 Impact Factor
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ABSTRACT: New criteria for Parkinson's disease-associated psychosis (PDAP) were recently proposed by a NINDS-NIMH working group. We assessed 116 consecutive unselected outpatients with PD for the existence of psychotic symptoms during the previous month, using a structured questionnaire covering the whole spectrum of PDAP symptoms. Hallucinations occurred in 42% of the patients (visual: 16%; nonvisual: 35%), delusions in 4%, and minor symptoms in 45% (sense of presence, visual illusions, or passage hallucinations). The prevalence of PDAP was 43% when the usual definition was used (hallucinations and/or delusions) and 60% when the NINDS-NIHM criteria were used. Correlations between PDAP and patient characteristics varied with the definition of PDAP. These findings suggest that the epidemiology of PDAP should be re-evaluated with the new criteria. Minor symptoms and nonvisual hallucinations are an important part of the PDAP spectrum, which has commonly been restricted to visual hallucinations and delusions. © 2010 Movement Disorder Society
Movement Disorders 04/2010; 25(6):763 - 766. · 4.51 Impact Factor
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ABSTRACT: New criteria for Parkinson's disease-associated psychosis (PDAP) were recently proposed by a NINDS-NIMH working group. We assessed 116 consecutive unselected outpatients with PD for the existence of psychotic symptoms during the previous month, using a structured questionnaire covering the whole spectrum of PDAP symptoms. Hallucinations occurred in 42% of the patients (visual: 16%; nonvisual: 35%), delusions in 4%, and minor symptoms in 45% (sense of presence, visual illusions, or passage hallucinations). The prevalence of PDAP was 43% when the usual definition was used (hallucinations and/or delusions) and 60% when the NINDS-NIHM criteria were used. Correlations between PDAP and patient characteristics varied with the definition of PDAP. These findings suggest that the epidemiology of PDAP should be re-evaluated with the new criteria. Minor symptoms and nonvisual hallucinations are an important part of the PDAP spectrum, which has commonly been restricted to visual hallucinations and delusions.
Movement Disorders 04/2010; 25(6):763-6. · 4.51 Impact Factor
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ABSTRACT: Psychotic symptoms are frequent and disabling in patients with Parkinson's disease (PD). Methodological issues in the epidemiology of PD associated psychosis (PDP) include differences in the symptoms assessed, the methods of assessment, and the selection of patients. Most studies are prospective clinic-based cross-sectional studies providing point prevalence rates in samples on dopaminergic treatment. Visual hallucinations are present in about one quarter to one third of the patients, auditory in up to 20%. Tactile/somatic, and olfactory hallucinations are usually not systematically sought. Minor phenomena such as sense of presence and visual illusions affect 17 to 72% of the patients, and delusions about 5%. Lifetime prevalence of visual hallucinations reaches approximately 50%. Prospective longitudinal cohort studies suggest that hallucinations persist and worsen in individual patients, and that their prevalence increases with time. A facilitating role of treatment on PDP is demonstrated at least for dopaminergic agonists, but there is no simple dose-effect relationship between dopaminergic treatment and the presence or severity of hallucinations. The main endogenous non-modifiable risk factor is cognitive impairment. Other associated factors include older age/longer duration of PD, disease severity, altered dream phenomena, daytime somnolence, and possibly depression and dysautonomia. PDP reduces quality of life in patients and increases caregiver distress, and is an independent risk factor for nursing home placement and development of dementia.
Journal of the neurological sciences 10/2009; 289(1-2):12-7. · 2.32 Impact Factor
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ABSTRACT: Patients with Parkinson disease (PD) can experience hallucinations (spontaneous aberrant perceptions) and illusions (misinterpretations of real perceptual stimuli). Of such phenomena, visual hallucinations (VHs) and illusions are the most frequently encountered, although auditory, olfactory and tactile hallucinations can also occur. In cross-sectional studies, VHs occur in approximately one-third of patients, but up to three-quarters of patients might develop VHs during a 20-year period. Hallucinations can have substantial psychosocial effects and, historically, were the main reason for placing patients in nursing homes. Concomitant or overlapping mechanisms are probably active during VHs, and these include the following: central dopaminergic overactivity and an imbalance with cholinergic neurotransmission; dysfunction of the visual pathways, including specific PD-associated retinopathy and functional alterations of the extrastriate visual pathways; alterations of brainstem sleep-wake and dream regulation; and impaired attentional focus. Possible treatments include patient-initiated coping strategies, a reduction of antiparkinson medications, atypical neuroleptics and, potentially, cholinesterase inhibitors. Evidence-based studies, however, only support the use of one atypical neuroleptic, clozapine, and only in patients without dementia. Better phenomenological discrimination, combined with neuroimaging tools, should refine therapeutic options and improve prognosis. The aim of this Review is to present epidemiological, phenomenological, pathophysiological and therapeutic aspects of hallucinations in PD.
Nature Reviews Neurology 07/2009; 5(6):331-42. · 12.46 Impact Factor
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Jean-Pascal Lefaucheur,
Jean-Marc Gurruchaga,
Bernard Pollin,
Florian von Raison,
Nabil Mohsen,
Masahiro Shin,
Isabelle Ménard-Lefaucheur,
Satoru Oshino,
Haruhiko Kishima, Gilles Fénelon,
Philippe Rémy,
Pierre Cesaro,
Inana Gabriel,
Pierre Brugières,
Yves Keravel,
Jean-Paul Nguyen
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ABSTRACT: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) gained general acceptance in the treatment of Parkinson's disease (PD).
To study the clinical outcome and the predicting factors of efficacy of chronic STN stimulation, while DBS electrodes were implanted under local or general anaesthesia with intra-operative electrophysiological guidance based on multi-unit recordings.
We included a large single-centre cohort of 54 patients with advanced PD (mean age: 59 years; disease duration: 14 years). Clinical evaluation was performed by the Unified Parkinson's Disease Rating Scale (UPDRS) before and 1 year after surgical placement of DBS electrodes.
In the on-stimulation and off-medication condition, the UPDRS part III score was reduced by 56% compared to the off-stimulation condition or pre-operative off-drug score. In the on-stimulation and on-medication condition, this score was reduced by 73%. The severity of motor fluctuations and dyskinesia (UPDRS part IV) and the activities of daily living (UPDRS part II) were reduced by 65 and 80%, respectively, in the on-stimulation/on-medication condition compared to the pre-operative baseline. The daily dose of antiparkinsonian treatment was diminished by 72%. Among the various pre- and intra-operative data, the most important predictive factor for clinical efficacy of STN stimulation was the length of hyperactivity along the best track observed in intra-operative multi-unit recordings. Other predictive factors included age, disease duration and pre-operative levodopa responsiveness or baseline off-drug values of the Hoehn and Yahr and UPDRS part III scores. In contrast, the type of anaesthesia (local vs. general) did not significantly influence the clinical outcome.
The present results are in the average of previously published results, but they have been obtained from a large single-centre cohort of patients with important reductions in the daily dose of antiparkinsonian drugs. This study confirmed the efficacy of the STN-DBS technique and emphasized the value of an original intra-operative electrophysiological approach based on multi-unit and not single-unit quantified recordings. This method allows DBS electrode implantation to be safely performed under general anaesthesia without lessening the rate of efficacy of the procedure.
European Neurology 08/2008; 60(4):186-99. · 1.81 Impact Factor
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Gilles Fénelon
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ABSTRACT: Psychosis in Parkinson's disease refers to a combination of hallucinations and delusions occurring with a clear sensorium and a chronic course. Hallucinations may involve several sensory modalities. Complex visual hallucinations are the most common type. "Minor" hallucinatory phenomena are frequently present and include visual illusions, passage hallucinations, and sense of presence. Insight may be lost in patients with cognitive impairment. Delusions of a paranoid type are more rare than hallucinations. Both hallucinations and delusions are more frequent in Parkinson's disease patients with dementia. Pathogenesis involves complex and probably multifactorial mechanisms, including pharmacologic (dopaminergic treatment and others) and disease-related factors.
CNS spectrums 04/2008; 13(3 Suppl 4):18-25. · 2.20 Impact Factor
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Hubert H Fernandez,
Dag Aarsland, Gilles Fénelon,
Joseph H Friedman,
Laura Marsh,
Alexander I Tröster,
Werner Poewe,
Olivier Rascol,
Cristina Sampaio,
Glenn T Stebbins,
Christopher G Goetz
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ABSTRACT: Psychotic symptoms are a frequent occurrence in Parkinson's disease (PD), affecting up to 50% of patients. The Movement Disorder Society established a Task Force on Rating Scales in PD, and this critique applies to published, peer-reviewed rating psychosis scales used in PD psychosis studies. Twelve psychosis scales/questionnaires were reviewed. None of the reviewed scales adequately captured the entire phenomenology of PD psychosis. While the Task Force has labeled some scales as "recommended" or "suggested" based on the fulfilling-defined criteria, none of the current scales contained all the basic content, mechanistic and psychometric properties needed to capture PD psychotic phenomena and to measure clinical response over time. Different scales may be better for some settings versus others. Since one scale may not be able to serve all needs, a scale used to measure clinical response and change over time [such as the Clinical Global Impression Scale (CGIS)] may need to be combined with another scale better at cataloging specific features [such as the Neuropsychiatric Inventory (NPI) or Schedule for Assessment of Positive Symptoms (SAPS)]. At the present time, for clinical trials on PD psychosis assessing new treatments, the following are recommended primary outcome scales: NPI (for the cognitively impaired PD population or when a caregiver is required), SAPS, Positive and Negative Syndrome Scale (PANSS), or Brief Psychiatric Rating Scale (BPRS) (for the cognitively intact PD population or when the patient is the sole informant). The CGIS is suggested as a secondary outcome scale to measure change and response to treatment over time.
Movement Disorders 04/2008; 23(4):484-500. · 4.51 Impact Factor
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ABSTRACT: 106 consecutive patients with Alzheimer's disease living in the community were examined in a memory clinic from a neurological department. They were screened for weight loss over the last 2 years. Age, duration of the disease, behavioral disorders, mini mental status examination, body mass index were recorded. Tumor necrosis factor alpha (TNFalpha), interleukin-1beta (IL-1beta), interleukin 6 (IL-6) and interleukin 2 (IL-2) blood levels were measured. Weight loss was reported in 42.5% of the patients. TNFalpha levels were significantly higher in these patients (18.8 versus 15.8 pg/mL; p=0.04) than in patients without weight loss. Weight loss was also associated with a lower MMSE score (16.9 versus 19.3; p=0.03), current pacing (20% versus 1.6%; p=0.002), and hallucinations (20.0% versus 3.3%; p=0.008). The levels of the other cytokines did not differ between the patients with and without weight loss. Our findings suggest an association between high levels of circulating TNFalpha and unexplained weight loss in Alzheimer's disease.
Psychologie & neuropsychiatrie du vieillissement 01/2007; 4(4):281-6. · 0.45 Impact Factor
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Emmanuel Roze,
Maria Clara Coêlho-Braga,
Dominique Gayraud,
André Pierre Legrand,
Jean-Marc Trocello, Gilles Fénelon,
Valérie Cochen,
Nathalie Patte,
François Viallet,
Marie Vidailhet,
Pierre Pollak,
Emmanuelle Apartis
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ABSTRACT: Head tremor is a typical feature of essential tremor. Patients with sporadic Parkinson's disease can have tremor of the tongue, lip, or chin, but classically do not have head tremor. We describe five patients with Parkinson's disease and head tremor in whom clinical and neurophysiological findings suggested that head tremor was a manifestation of Parkinson's disease.
Movement Disorders 09/2006; 21(8):1245-8. · 4.51 Impact Factor
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ABSTRACT: Whether chronic hallucinations belong to the natural history of untreated Parkinson disease (PD) remains undetermined. For early authors such as Gowers or Charcot and his followers, hallucinations that occurred in the course of PD either accompanied the final phase of the disease or reflected comorbidities. However, a few authors observed that hallucinations could occur in PD patients with severe depression, confusion, or dementia. Interest in hallucinations with parkinsonism increased with the outbreak of von Economo encephalitis, as they were more frequent than in PD, provoking new pathophysiologic questions. Later studies on mental symptoms in parkinsonism were often based on series that pooled patients with PD and postencephalitic syndromes, confounding a clear analysis. It remains difficult to estimate the prevalence of hallucinations in the natural course of PD before the introduction of levodopa therapy. The lack of prospective studies, the wide early use of anticholinergics and ergots compounds, and the absence of dementia with Lewy bodies in the nosology of the time are further limitations. Even with these limitations, historical descriptions of PD from the prelevodopa era suggest that hallucinations may be part of PD itself, especially in the context of late dementia, depression, or nonspecific encephalopathy.
Neurology 02/2006; 66(1):93-8. · 8.31 Impact Factor
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Gilles Fénelon
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ABSTRACT: Psychic disturbances are frequently present in patients with Parkinson's disease. They increase the disability and handicap, contribute to poor quality of life and often make the treatment of motor symptoms more difficult. Cognitive impairment may be restricted to subtle changes on neuropsychological testing, but the evolution towards a dementia appears more frequent than previously thought. Depression, anxiety and hallucinations are common but may be underestimated. During recent years, new psychiatric aspects have been described such as apathy and the so-called syndrome of dopamine dysregulation.
La Revue du praticien 05/2005; 55(7):733-9.
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Gilles Fénelon
La Revue du praticien 05/2005; 55(7):714-6.
